瑞芬太尼复合丙泊酚或七氟醚控制性降压对鼻内镜手术的影响

Effect of remifentanil combined with propofol or sevoflurane on controlled hypotension in endoscopic sinus surgery

目的探讨瑞芬太尼复合丙泊酚或七氟醚控制性降压对鼻内镜手术的影响。方法选取银川市第三人民医院择期行内镜鼻窦手术的患者61例,按随机数字表法将其分为丙泊酚组(n=31)和七氟醚组(n=30)。两组均采用气管内插管静吸复合全麻,麻醉诱导和维持输注瑞芬太尼的方法相同,丙泊酚组术中同时输注丙泊酚维持控制降压,七氟醚组术中同时吸入七氟醚维持控制降压。比较两组的术中降压达标时间、出血量及手术时间;比较两组不同时间的平均动脉压(MAP)、心率(HR)、术野质量评分、肾素、血管紧张素Ⅱ、醛固酮水平。结果两组的降压达标时间和手术时间比较,差异无统计学意义(P>0.05);丙泊酚组的出血量少于七氟醚组(P<0.05)。两组降压前、降压后30 min及术后30 min的MAP和HR比较,差异无统计学意义(P>0.05)。随着手术进行,两组患者的术野质量评分逐渐降低(P<0.05);手术开始后25 min(T_(3))、35 min(T_(4)),丙泊酚组的术野质量评分低于七氟醚组(P<0.05)。手术后,两组的肾素、血管紧张素Ⅱ、醛固酮水平均升高,但丙泊酚组的肾素水平低于七氟醚组(P<0.05)。结论在鼻内镜手术麻醉过程中,采用瑞芬太尼复合丙泊酚比瑞芬太尼复合七氟醚更能减少患者的出血量,进而改善手术视野,并能控制血压和心率,具有较高的安全性及临床使用价值。

Objective To investigate the effect of remifentanil combined with propofol or sevoflurane on controlled hypotension in endoscopic sinus surgery.Methods A total of 61 patients undergoing endoscopic sinus surgery in the third people's hospital of Yinchuan were selected and divided into propofol group(n=31)and sevoflurane group(n=30)according to random number table method.Both groups were treated with endotracheal intubation combined with general anesthesia,and the methods of anesthesia induction and maintenance infusion of remifentanil were the same.Propofol was infused simultaneously in the propofol group to maintain and control hypotension,and sevoflurane was inhaled simultaneously in the sevoflurane group to maintain and control hypotension.The blood pressure reaching standard time,blood loss and operation time were compared between the two groups;the mean arterial pressure(MAP),heart rate(HR),surgical field quality score,renin,angiotensin Ⅱ and aldosterone levels were compared between the two groups at different times.Results There were no significant differences in blood pressure reaching standard time and operation time between the two groups(P>0.05);the bleeding volume of the propofol group was less than that of the sevoflurane group(P<0.05).There were no statistically significant differences in MAP and HR between the two groups before,30 min after hypotension,and 30 min after surgery(P>0.05).As the operation progressed,the surgical field quality score of the two groups of patients gradually decreased(P<0.05);at 25 min(T_(3))and 35 min(T_(4))after the start of the operation,the surgical field quality score of the propofol group was lower than that of the sevoflurane group(P<0.05).After the operation,the levels of renin,angiotensin Ⅱ and aldosterone increased in the two groups,but the level of renin in the propofol group was lower than that in the sevoflurane group(P<0.05).Conclusion In the process of nasal endoscopic surgery anesthesia,the use of remifentanil combined with propofol can reduce the patients'bleeding more than remifentanil combined with sevoflurane,thereby improving the surgical field of vision,and controlling blood pressure and heart rate,which has high safety and clinical application value.